Nurse Staffing Math Doesn’t Make Cents

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What does a low census mean?

For us it means high acuity patients, low staffing, and horribly busy nights.

I must say, I am a bit apprehensive about my impending shift. Apparently the less patients you have, your patient to nurse ratio increases, and you don’t get a tech to help do vital signs. Once I’ve finally gotten everyone settled, its been 4 hours, I have to go around, wake everybody up, and start the process all over again.

I try my very best to chart as I go. It is the the best thing to do, really. You get the most accurate time on your charting, the information is fresh, and it ensures that the information get recorded. Bedside charting is even ideal, but often times I attempt to let me patients sleep as much as possible, and the clickity-clack of the keyboard doesn’t exactly fall in the category of white noise to most.

Which is the lesser of two evils? The patients privacy and rest come before my need to chart at bedside, so I resign to the nurses station to record the details of the events and precisely as possible. But, I digress.

We chart by exception. However, it seems that this is not true, but we are always rewriting information, putting vital signs in more than one place, and charting that we rounded on our patients. Of course I round on my patients! The exception would be if I did not round on my patient. I’m not sure what Medicaid or other insurance genius figured out these rules. The problem with these sort of things is that these nit-picky, “any good nurse would do”, redundant, and irritating ‘interventions’ I am forced to check off often distract me from being able to chair the important information. Often I am so busy trying to satisfy the computers needs that I am fearful I will forget to chart things that actually matter like dressing changes, iv sticks, you know, things I actually did and used technical skills to perform. The things I actually spend the most time on often get disregarded in the requirements that the computer spits at me.

Does the the scripted boxes of yes and no’s and the repeated fill in the blanks actually prove I took care of the patient? What about the nurses who only fill out those forms and never actually write an actual narrative note? Is this the right thing to do?

In years I am sure it will be more clear to be, but we seriously have to fix this. Communication is so key in the the care of our patients, and these repeating screens don’t fulfill the task nearly as elegantly as they should. Does having me click yes or no ensure the task was completed?

I don’t know.

I do know that I am crossing my fingers for a tech tonight so that I won’t be irritated so severely by the required boxes and I will have an opportunity to chart narratively as much as I feel needed. I think that my patients and their insurers would be appreciative of that.

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Really, it doesn’t make much monetary sense for the hospital to cut our tech. Save $120 by eliminating one staff member, but then loose $400 because one IV stick isn’t documented accurately.

If its about dollars, clearly someone isn’t paying attention to their math, because this doesn’t make any cents. two_cents_0

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6 thoughts on “Nurse Staffing Math Doesn’t Make Cents”

  1. I just got off my 7a-7p week end shifts. Exhausted as usual and tired of saying, “we need more staff to do this job safely and with compassion”! I know that staffing is vastly complicated and expensive, but so is safety and quality of care. We can do better! I so relate to that sense of dread going into a shift. Will there be enough LNA’s and will they be experienced on the unit and work well together and will I be able to be an effective leader for the team?

    Check out my new 12 min YouTube called “Interruption Awareness: A Nursing Minute for Patient Safety”.

    I think I need to work on an article that focuses on what would be different when we have enough staff!!! Ok it is on my list!


  2. Exactly! Wish I could sit down with a pen and paper and spell it out for them sometimes, but my efforts would likely be in vain.

  3. We have gone to electronic PCR's and luckily, I have 2 hours after the ED receives the patient to complete my PCR and fax it to the ED. There are times when I get back to back calls and it is 6 hours later and I have not touched a PCR and that puts me over the edge!!! I can't imagine what it is like to have NO time to do your charts. And, I am all about narratives. I agree…I do the checkboxes because they are there but the narrative is best. Especially if I am ever going to be called upon to remember what I did or didn't do! Good luck and I hope they realize that cutting a tech can cost a LOT more than $400 bucks if something happens due to lack of staffing!

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